| Doctor Name: | CHARLES JEFFREY SIDLOW |
| NPI Number: | 1033179270 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.P.M. |
| License Number: | POD000560 |
| Business Practice Address: | 958 Joe Frank Harris Pkwy Se Bldg A Suite 106 Cartersville, GA - 301202175 |
| Business Phone Number: | 7703861389 |
| Business Fax Number: | 7703864894 |
| Mailing Address: | 958 Joe Frank Harris Pkwy Se Bldg A, Suite 106 CARTERSVILLE |
| State: | GA |
| Postal Code: | 301202175 |
| Phone Number: | 7703861389 |
| Fax Number: | 7703864894 |
| NPI Enumeration Date: | 03/23/2006 |
| NPI Last Update Date: | 12/19/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213EP1101X |
| License Number: | POD000560 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Primary Podiatric Medicine |
| Taxonomy Definition: | |